Intracapsular neck of femur fractures secondary to civilian gunshot injuries: an inter- and intra-observer agreement study on classification and treatment using the AO/OTA classification.

PURPOSE: Numerous classification systems have been developed for neck of femur fractures, but none have been tested for reliability in gunshot injuries. Our primary objective was to assess the inter-observer and intra-observer reliability of the AO/OTA classification system when applied to intracapsular neck of femur fractures secondary to low-velocity civilian gunshots wounds (GSWs). Our secondary objective was to test the reliability of the AO/OTA classification system in guiding surgeon treatment choices for these fractures. PATIENTS AND METHODS: Eighteen reviewers (six orthopaedic traumatologists, six general orthopaedic surgeons and six junior orthopaedic fellows) were given a set of 25 plain radiographs and CT scans of femur neck fractures secondary to GSW. For each clinical case, all reviewers selected a classification as well as treatment option from a list of given options. Inter-observer reliability was measured at the initial classification. The exercise was repeated 10-12 weeks later by the same 18 reviewers to test intra-observer reliability. RESULTS: The Fleiss kappa values indicate only slight agreement amongst raters, across all experience levels, for both injury classification and treatment. Intra-observer agreement was fair across all experience levels for both injury classification and treatment. CONCLUSION: The AO/OTA classification showed only slight reliability in classification of gunshot fractures of the femur neck. With only fair reliability, it also failed to guide surgical treatment thus rendering its routine use in daily clinical practice of questionable value.

A low-cost phantom design for evaluating spine SABR calculations in the presence of prosthetic vertebral stabilization.

Dose-perturbation characteristics are important to consider during the calculation of radiation therapy protocols for patients who are going to receive high doses that would reach the tolerance limits of the spinal cord [1]. Several studies have investigated dose perturbations introduced by metal implants in close proximity to spine SABR treatments [2-7]. However, there is a lack of work assessing this effect using the RayStation TPS [8]. We present an initial design for a low-cost phantom to evaluate spine stereotactic ablative radiotherapy (SABR) in the presence of prosthetic vertebral stabilization. The phantom is modular, allowing the prosthetic at the centre of the phantom to be removed by exchanging the central block. It also includes space to insert ion chamber and film. The agreement of the RayStation TPS (v8.0B) collapsed cone convolution (CCC) calculation and measurement was determined for phantom versions with and without prosthetic. There was little to no change in the agreement between the measured and calculated dose when introducing metallic hardware. This suggests that our Raystation-based SABR planning approach for patients with spinal hardware meets clinical expectations. Departments without access to anthropomorphic phantoms may find this design useful but should test their phantom design in typical clinical settings to ensure it is robust to real world situations.

Sleep and cognition in South African patients with non-functioning pituitary adenomas.

Strong lines of evidence in the neuroscience literature indicate that (a) healthy sleep facilitates cognitive processing, and (b) sleep disruption is associated with cognitive dysfunction. Despite the fact that patients with pituitary disease often display both disrupted sleep and cognitive dysfunction, few previous studies investigate whether these clinical characteristics in these patients might be related. Hence, we explored whether sleep disruption in patients with pituitary disease mediates their cognitive dysfunction. We recruited 18 patients with non-functioning pituitary adenomas (NFPA) and 19 sociodemographically matched healthy controls. They completed the Global Sleep Assessment Questionnaire (thus providing self-report data regarding sleep disruption) and were administered the Brief Test of Adult Cognition by Telephone, which assesses cognitive functioning in the domains of processing speed, working memory, episodic memory, inhibition, and reasoning. We found no significant differences in cognition between patients and controls. Furthermore, spectra of sleep disturbance did not differ significantly between patients and controls. Our data suggest that NFPA patients' cognition and sleep quality is relatively intact, and that sleep disruption does not mediate cognitive dysfunction. Larger studies should characterize sleep and cognition in patients with NFPA (and other pituitary diseases) to confirm whether disruption of the former mediates impairment in the latter.

Scarring and Dyschromias in Fitzpatrick Skin Type IV-VI: A Review of Dermatologic Treatment Protocols.

IMPORTANCE: Managing chronic conditions is an essential aspect of dermatologic care, especially regarding the resolution of inflammatory dermatologic disease and recovery of skin lesions. Short-term complications of healing include infection, edema, dehiscence, hematoma formation, and tissue necrosis. At the same time, longer-term sequelae may consist of scarring and scar widening, hypertrophic scars, keloids, and pigmentary changes. This review will focus on dermatologic complications of chronic wound healing in patients with Fitzpatrick skin type (FPS) IV-VI or skin of color (SOC), with an emphasis on hypertrophy/scarring and dyschromias. It will focus on current treatment protocols and the potential complications specific to patients with FPS IV-VI. OBSERVATIONS: There are multiple complications of wound healing that are more prevalent in SOC, including dyschromias and hypertrophic scarring. These complications are challenging to treat, and current protocols are not without complications and side effects that must be considered when offering therapy to patients with FPS IV-VI. CONCLUSIONS AND RELEVANCE: When treating pigmentary and scarring disorders in patients with skin types FPS IV-VI, it is essential to implement a stepwise approach to management that is conscious of the side effect profile of current interventions. J Drugs Dermatol. 2023;22(7): doi:10.36849/JDD.7253.

Scarring and Dyschromias in Fitzpatrick Skin Type IV-VI: A Review of Dermatologic Treatment Protocols.

IMPORTANCE: Managing chronic conditions is an essential aspect of dermatologic care, especially regarding the resolution of inflammatory dermatologic disease and recovery of skin lesions. Short-term complications of healing include infection, edema, dehiscence, hematoma formation, and tissue necrosis. At the same time, longer-term sequelae may consist of scarring and scar widening, hypertrophic scars, keloids, and pigmentary changes. This review will focus on dermatologic complications of chronic wound healing in patients with Fitzpatrick skin type (FPS) IV-VI or skin of color (SOC), with an emphasis on hypertrophy/scarring and dyschromias. It will focus on current treatment protocols and the potential complications specific to patients with FPS IV-VI.  Observations: There are multiple complications of wound healing that are more prevalent in SOC, including dyschromias and hypertrophic scarring. These complications are challenging to treat, and current protocols are not without complications and side effects that must be considered when offering therapy to patients with FPS IV-VI.  Conclusions and Relevance: When treating pigmentary and scarring disorders in patients with skin types FPS IV-VI, it is essential to implement a stepwise approach to management that is conscious of the side effect profile of current interventions. J Drugs Dermatol. 2023;22(3):288-296. doi:10.36849/JDD.7253.

Review of the microbiome in skin aging and the effect of a topical prebiotic containing thermal spring water.

BACKGROUND: Interest in the skin microbiome and the cosmetic benefits of probiotics, prebiotics, and postbiotics is increasing. AIM: The current review explores the influence of the skin microbiome on facial skin aging and the effects of oral and topical probiotics, prebiotics, and postbiotics use on skin aging and cosmetic outcomes. METHODS: Five dermatologists who treat clinical signs of facial skin aging and a microbiome scientist (advisors) explored the relationship between the skin microbiome and skin aging. Published evidence and the advisors' knowledge lead to guidance on the skin microbiome using oral and topical prebiotics, probiotics, and postbiotics to reduce signs of aging. RESULTS: The role of the microbiome in aging skin is an emerging concept. A diverse skin microbiome is essential for skin health. Preliminary studies suggest oral probiotics and prebiotics may play a role in reducing signs of skin aging, likely through shifting to a greater skin and gut microbiome diversity. Thermal spring water contains probiotics and prebiotics. Preliminary studies suggest topically applied probiotics, prebiotics, and postbiotics may improve signs of skin aging, including a reduction in fine lines and increased hydration. CONCLUSIONS: The panel agreed that oral and topical prebiotics, probiotics, and postbiotics may play a role in improving signs of aging by improving the skin microbiome. Larger studies with more prolonged treatment trials are needed to better understand the microbiome's role in skin aging and the possible benefits of prebiotics, probiotics, and postbiotics use.

Preferential consolidation of emotional reactivity during sleep: A systematic review and meta-analysis.

Many studies have investigated whether sleep affects cognitively unmodulated reactivity to emotional stimuli. These studies operationalize emotion regulation by using subjective and/or objective measures to compare pre- and post-sleep reactivity to the same emotional stimuli. Findings have been inconsistent: some show that sleep attenuates emotional reactivity, whereas others report enhanced or maintained reactivity. Across-study methodological differences may account for discrepant findings. To resolve the questions of whether sleep leads to the attenuation, enhancement, or maintenance of emotional reactivity, and under which experimental conditions particular effects are observed, we undertook a synthesized narrative and meta-analytic approach. We searched PubMed, PsycINFO, PsycARTICLES, Web of Science, and Cochrane Library databases for relevant articles, using search terms determined a priori and search limits of language = English, participants = human, and dates = January 2006-June 2021. Our final sample included 24 studies that investigated changes in emotional reactivity in response to negatively and/or positively valenced material compared to neutral material over a period of sleep compared to a matched period of waking. Primary analyses used random effects modeling to investigate whether sleep preferentially modulates reactivity in response to emotional stimuli; secondary analyses examined potential moderators of the effect. Results showed that sleep (or equivalent periods of wakefulness) did not significantly affect psychophysiological measures of reactivity to negative or neutral stimuli. However, self-reported arousal ratings of negative stimuli were significantly increased post-sleep but not post-waking. Sub-group analyses indicated that (a) sleep-deprived participants, compared to those who slept or who experienced daytime waking, reacted more strongly and negatively in response to positive stimuli; (b) nap-exposed participants, compared to those who remained awake or who slept a full night, rated negative pictures less negatively; and (c) participants who did not obtain substantial REM sleep, compared to those who did and those exposed to waking conditions, had attenuated reactivity to neutral stimuli. We conclude that sleep may affect emotional reactivity, but that studies need more consistency in methodology, commitment to collecting both psychophysiological and self-report measures, and should report REM sleep parameters. Using these methodological principles would promote a better understanding of under which conditions particular effects are observed.

Impact of HIV on Cognitive Performance in Professional Drivers.

BACKGROUND: The intellectually demanding modern workplace is often dependent on good cognitive health, yet there is little understanding of how neurocognitive dysfunction related to HIV presents in employed individuals working in high-risk vocations such as driving. HIV-associated neurocognitive impairment is also associated with poorer long-term cognitive, health, and employment outcomes. SETTING: This study, set in Cape Town, South Africa, assessed the effects of HIV on neuropsychological test performance in employed male professional drivers. METHOD: We administered a neuropsychological test battery spanning 7 cognitive domains and obtained behavioral data, anthropometry, and medical biomarkers from 3 groups of professional drivers (68 men with HIV, 55 men with cardiovascular risk factors, and 81 controls). We compared the drivers' cognitive profiles and used multiple regression modeling to investigate whether between-group differences persisted after considering potentially confounding sociodemographic and clinical variables (ie, income, home language, depression, and the Framingham risk score). RESULTS: Relative to other study participants, professional drivers with HIV performed significantly more poorly on tests assessing processing speed (P < 0.003) and attention and working memory (P = 0.018). Group membership remained a predictor of cognitive performance after controlling for potential confounders. The cognitive deficits observed in men with HIV were, however, largely characterized as being mild or asymptomatic. Consistent with this characterization, their relatively poor performance on neuropsychological testing did not generalize to self-reported impairment on activities of daily living. CONCLUSION: Drivers with HIV may be at risk of poorer long-term health and employment outcomes. Programs that monitor and support their long-term cognitive health are needed.

Next Generation Sequencing of Single Nucleotide Polymorphic DNA-Markers in Selecting for Intramuscular Fat, Fat Melting Point, Omega-3 Long-Chain Polyunsaturated Fatty Acids and Meat Eating Quality in Tattykeel Australian White MARGRA Lamb.

Meat quality data can only be obtained after slaughter when selection decisions about the live animal are already too late. Carcass estimated breeding values present major precision problems due to low accuracy, and by the time an informed decision on the genetic merit for meat quality is made, the animal is already dead. We report for the first time, a targeted next-generation sequencing (NGS) of single nucleotide polymorphisms (SNP) of lipid metabolism genes in Tattykeel Australian White (TAW) sheep of the MARGRA lamb brand, utilizing an innovative and minimally invasive muscle biopsy sampling technique for directly quantifying the genetic worth of live lambs for health-beneficial omega-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFA), intramuscular fat (IMF), and fat melting point (FMP). NGS of stearoyl-CoA desaturase (SCD), fatty acid binding protein-4 (FABP4), and fatty acid synthase (FASN) genes identified functional SNP with unique DNA marker signatures for TAW genetics. The SCD g.23881050T>C locus was significantly associated with IMF, C22:6n-3, and C22:5n-3; FASN g.12323864A>G locus with FMP, C18:3n-3, C18:1n-9, C18:0, C16:0, MUFA, and FABP4 g.62829478A>T locus with IMF. These add new knowledge, precision, and reliability in directly making early and informed decisions on live sheep selection and breeding for health-beneficial n-3 LC-PUFA, FMP, IMF and superior meat-eating quality at the farmgate level. The findings provide evidence that significant associations exist between SNP of lipid metabolism genes and n-3 LC-PUFA, IMF, and FMP, thus underpinning potential marker-assisted selection for meat-eating quality traits in TAW lambs.

Sleep, Cognition and Cortisol in Addison's Disease: A Mechanistic Relationship.

Sleep is a critical biological process, essential for cognitive well-being. Neuroscientific literature suggests there are mechanistic relations between sleep disruption and memory deficits, and that varying concentrations of cortisol may play an important role in mediating those relations. Patients with Addison's disease (AD) experience consistent and predictable periods of sub- and supra-physiological cortisol concentrations due to lifelong glucocorticoid replacement therapy, and they frequently report disrupted sleep and impaired memory. These disruptions and impairments may be related to the failure of replacement regimens to restore a normal circadian rhythm of cortisol secretion. Available data provides support for existing theoretical frameworks which postulate that in AD and other neuroendocrine, neurological, or psychiatric disorders, disrupted sleep is an important biological mechanism that underlies, at least partially, the memory impairments that patients frequently report experiencing. Given the literature linking sleep disruption and cognitive impairment in AD, future initiatives should aim to improve patients' cognitive performance (and, indeed, their overall quality of life) by prioritizing and optimizing sleep. This review summarizes the literature on sleep and cognition in AD, and the role that cortisol concentrations play in the relationship between the two.

Rates of cognitive impairment in a South African cohort of people with HIV: variation by definitional criteria and lack of association with neuroimaging biomarkers.

There is wide variation in the reported prevalence of cognitive impairment in people with HIV (PWH). Part of this variation may be attributable to different studies using different methods of combining neuropsychological test scores to classify participants as either cognitively impaired or unimpaired. Our aim was to determine, in a South African cohort of PWH (N = 148), (a) how much variation in reported rates was due to method used to define cognitive impairment and (b) which method correlated best with MRI biomarkers of HIV-related brain pathology. Participants completed detailed neuropsychological assessment and underwent 3 T structural MRI and diffusion tensor imaging (DTI). We used the neuropsychological data to investigate 20 different methods of determining HIV-associated cognitive impairment. We used the neuroimaging data to obtain volumes for cortical and subcortical grey matter and total white matter and DTI metrics for several white matter tracts. Applying each of the 20 methods to the cognitive dataset resulted in a wide variation (20-97%) in estimated rates of impairment. Logistic regression models showed no method was associated with HIV-related neuroimaging abnormalities as measured by structural volumes or DTI metrics. We conclude that for the population from which this sample was drawn, much of the variation in reported rates of cognitive impairment in PWH is due to the method of classification used, and that none of these methods accurately reflects biological effects of HIV in the brain. We suggest that defining HIV-associated cognitive impairment using neuropsychological test performance only is insufficient; pre-morbid functioning, co-morbidities, cognitive symptoms, and functional impairment should always be considered.

Assessing HIV provider knowledge, screening practices, and training needs for HIV-associated neurocognitive disorders. A short report.

Management of HIV-associated neurocognitive disorders (HAND) is becoming increasingly important with HIV-positive people living normal life spans. We aimed to establish the level of HAND awareness among doctor and nurse occupational health practitioners, screening used to detect impairment, factors limiting screening for HAND, and training needs. One-hundred-and-five members of the nursing and physician professional societies for occupational health practitioners in South Africa and Occupational Health Departments at five South African universities responded to an email invitation to complete an online survey addressing demographics, HAND knowledge, screeners being used to screen for HAND and related training needs. While 80% had heard of HAND, few (13.3%) were aware of the Frascati criteria. Only 2% had received training addressing HAND; 11.4% screened for HAND; 45.7% did not know what screening tool to us; 80% preferred spending <15 min on screening. The largest obstacle to screening was lack of expertise (77.1%) but 77.3% thought it important to screen for HAND. 94.3% wanted screening training. Health providers are poorly informed about HAND and lack expertise and tools to screen for HAND in their treatment programs. While few had relevant training, they recognize the importance of screening for HAND in the workplace and desire training.

Sociodemographic and psychosocial predictors of longitudinal antiretroviral therapy (ART) adherence among first-time ART initiators in Cape Town, South Africa.

First-time antiretroviral therapy (ART) initiators may be more vulnerable to poor ART adherence because they may be coping with a new HIV diagnosis, facing logistical challenges to accessing and adhering to ART for the first time, and have not yet developed support networks or the skills to support long-term adherence. We recruited 324 participants in two HIV clinics near Cape Town, South Africa. Sociodemographic/psychosocial factors were measured at baseline and self-reported adherence at the 6 month follow-up. We conducted multivariable regression to determine which baseline factors were associated with 6-month adherence. A better patient-clinic relationship score (OR: 1.08 [95% CI: 1.05-1.11]) was associated with higher adherence. A drug use problem (0.51 [0.29-0.87]), higher social isolation (0.93 [0.87-0.99]), and greater number of years living with HIV before initiating ART (0.92 [0.86-1.00]) were associated with adherence levels below 90%. Patient-clinic relationships and social support are key psycho-social factors in early adherence behavior. Reducing drug use problems through targeted screening and early intervention may improve ART adherence.

Genetics of Omega-3 Long-Chain Polyunsaturated Fatty Acid Metabolism and Meat Eating Quality in Tattykeel Australian White Lambs.

Meat eating quality with a healthy composition hinges on intramuscular fat (IMF), fat melting point (FMP), tenderness, juiciness, flavour and omega-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFA) content. These health-beneficial n-3 LC-PUFA play significant roles in optimal cardiovascular, retinal, maternal and childhood brain functions, and include alpha linolenic (ALA), eicosapentaenoic (EPA), docosahexaenoic (DHA) and docosapentaenoic (DPA) acids. The primary objective of this review was to access, retrieve, synthesise and critically appraise the published literature on the synthesis, metabolism and genetics of n-3 LC-PUFA and meat eating quality. Studies on IMF content, FMP and fatty acid composition were reviewed to identify knowledge gaps that can inform future research with Tattykeel Australian White (TAW) lambs. The TAW is a new sheep breed exclusive to MARGRA brand of lamb with an outstanding low fat melting point (28-39°C), high n-3 LC-PUFA EPA+DHA content (33-69mg/100g), marbling (3.4-8.2%), tenderness (20.0-38.5N) and overall consumer liking (7.9-8.5). However, correlations between n-3 LC-PUFA profile, stearoyl-CoA desaturase (SCD), fatty acid binding protein 4 (FABP4), fatty acid synthase (FASN), other lipogenic genes and meat quality traits present major knowledge gaps. The review also identified research opportunities in nutrition-genetics interactions aimed at a greater understanding of the genetics of n-3 LC-PUFA, feedlot finishing performance, carcass traits and eating quality in the TAW sheep. It was concluded that studies on IMF, FMP and n-3 LC-PUFA profiles in parental and progeny generations of TAW sheep will be foundational for the genetic selection of healthy lamb eating qualities and provide useful insights into their correlations with SCD, FASN and FABP4 genes.

Methods of deliberate self-harm in a tertiary hospital in South Africa.

BACKGROUND: Little is known about the methods of deliberate self-harm (DSH) in South Africa (SA), despite the importance of means restriction as a public health strategy to reduce the morbidity and mortality associated with self-harm. AIM: The aim of this study was to investigate the range of methods used in DSH and identify the socio-demographic and clinical factors associated with violent and non-violent methods of DSH among patients treated at a tertiary hospital in SA. SETTING: The study was conducted at an urban, tertiary level emergency department at Groote Schuur hospital in Cape Town, South Africa. METHOD: Data were collected from 238 consecutive DSH patients who presented for emergency department treatment at the hospital. Logistic regression models were used to explore the factors associated with violent and non-violent methods of DSH. RESULTS: Self-poisoning was the most common method of self-harm (80.3%). Prescription medication was the most common form of self-poison (57.6%), while a large number of patients used non-prescription paracetamol (40.9%). In the regression analysis, male gender, stating that the reason for DSH was to escape a situation and history of substance use were associated with violent method of DSH. CONCLUSION: Improved monitoring of prescription medications commonly used in DSH is integral to public health suicide prevention strategies in SA. This study underscores the need for substance use interventions in the healthcare setting.

Validating the European randomised study for screening of prostate cancer (ERSPC) risk calculator in a contemporary South African cohort.

INTRODUCTION: Numerous prostate cancer predictive tools have been developed to help with decision-making in men needing prostate biopsy. However, they have been modelled and validated almost exclusively in Caucasian cohorts, hence limiting their use in other population groups. The aim of this study was to assess the validity of the ERSPC risk calculator in a South African cohort. METHODS: Patients who have had a transrectal ultrasound (TRUS)-guided prostate biopsy at Groote Schuur Hospital from January 2008 to August 2017 were reviewed. Predictor variables were entered into the ERSPC risk calculator and results were compared with prostate biopsy pathology results. Predictive accuracy of the ERSPC risk calculator for these patients was derived using receiver operator characteristics (ROC) Area under the curve and is expressed as a percentage. RESULTS: 516 prostate biopsy sessions in 475 different men were analysed. The predictive accuracy of the ERSPC risk calculator was better than a PSA/DRE strategy for the presence of cancer-0.738 (95% CI 0.695-0.781) vs 0.686 (95% CI 0.639-0.732), and for significant PCa-0.833 (95% CI 0.789-0.876) vs 0.793 (95% CI 0.741-0.846). This translated into 50 less biopsies when compared to a PSA > 4/abnormal DRE strategy. Use of the ERSPC RC would have missed eight non-significant cancers [Significant cancer being defined as having a tumour stage T2b (> 1/2 lobe involved with prostate cancer) and/or a Gleason Score equal to or greater than 7]. CONCLUSION: Our results confirm the validity of the ERSPC RC in a South African cohort. Application of this calculator to the wider South African population would allow better selection of patients for prostate biopsy and spare a significant number its adverse consequences.

Home-versus acquired-language test performance on the Hopkins Verbal Learning Test-Revised among multilingual South Africans.

The Hopkins Verbal Learning Test-Revised (HVLT-R) has been adapted for use in many different languages and in low- and middle-income countries. However, few adaptations have evaluated performance differences between home- and acquired-language administrations. The present study examined performance on an adapted HVLT-R between multilingual South Africans who chose to be tested in a home or acquired language. The HVLT-R was administered to 112 multilingual, isiXhosa as home language, Black South African adults (49% men) with no major medical, neurological, or psychiatric problems. Sixty-one preferred to take the test in isiXhosa and 51 preferred English. We examined between-language differences in word equivalency, primary scores, learning indices, and serial position effects. We also examined language, age, education, and gender on test performance. English-examinees were significantly younger and more educated than isiXhosa-examinees (p's < .05). Although isiXhosa words had more letters and syllables than English words (p's <.001), there were no significant differences between groups on HVLT-R performance or serial recall (p's > .05). More education and being a woman predicted better Total and Delayed Recall (p's<.05). Performance on this modified HVLT-R appears similar between English and isiXhosa administrations among South African isiXhosa first language speakers, which makes comparisons between preferred language administrations appropriate.

Perennial Ryegrass Alkaloids Increase Respiration Rate and Decrease Plasma Prolactin in Merino Sheep under Both Thermoneutral and Mild Heat Conditions.

A study was undertaken to determine the effects of feeding two levels of perennial ryegrass alkaloids (nil vs. moderate) under two climatic conditions. Alkaloids were fed via endophyte-infected perennial ryegrass seed and hay. Twenty-four Merino ewe weaners (six months, initial BW 32 ± 1.7 kg) were used in a study that lasted for 21 days after 14 days of adaptation. Sheep were fed either a control or alkaloid (Alk, 110 µg/kg LW ergovaline and 75 µg/kg LW lolitrem B) supplemented diet. Sheep were exposed to either constant thermoneutral (TN, 21-22 °C, 49% RH) or mildly heated (HS, 33 °C 1000-1500 h, 28% relative humidity) conditions. Dietary Alk and HS reduced dry matter intake (DMI) (p < 0.001, p = 0.02, respectively) with the combination of both reducing DMI by 42%. Reductions in DMI resulted in a lower daily gain in the Alk treatment (p < 0.001). Feed digestibility was reduced in the combined treatment (p = 0.03). Rectal temperature, respiration rate, and skin temperature increased in the Alk treatment. Plasma prolactin concentrations were decreased by Alk and increased by mild HS. The data indicate that production is compromised in the presence of Alk and mild HS, with this effect being exacerbated by a combination of both.

Depressive symptoms and associated factors in medical interns at a tertiary hospital.

BACKGROUND: It is known that medical doctors suffer from increased rates of depression with medical interns being most at risk. Despite this, little is known about the prevalence of depression in interns in South Africa. OBJECTIVES: This study aimed to assess the prevalence of depressive symptoms in interns employed at Groote Schuur Hospital, a tertiary hospital in the Western Cape. METHOD: The study was a cross-sectional study. All 91 interns were invited to participate in the study and consenting interns were required to complete a demographic and related questionnaire and the Beck Depression Inventory 2 (BDI-2). RESULTS: Fifty-four (59.3%) of all invited interns participated in the study. Twenty-two interns (40.7%) reported a BDI-2 score of 14 or greater, indicating at least mild self-reported symptoms of depression. Features associated with a BDI-2 score of 14 or greater, included female gender, a previous diagnosis of depression, seeing a psychotherapist and previously being on antidepressant medication during internship. Other features also significantly associated with higher BDI-2 scores included suicidal ideation, thoughts of emigration, wanting to leave medicine and using substances to cope. The most significant associated feature of high BDI-2 scores was a subjective feeling of being 'burnt out'. CONCLUSION: Interns had a higher prevalence of depressive symptoms when compared to the general population. The feeling of being 'burnt out' was the most significant factor associated with the severity of depressive symptoms. It is imperative that the mental health of both medical students and newly qualified doctors be prioritised, supported and monitored.